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PubMedDate not supplied

Prognostic value of DNA ploidy patterns of colorectal adenocarcinoma.

BACKGROUND/AIMS: The significance of prognostic value of DNA ploidy patterns of colorectal cancer has not yet been fully understood. The present study was designed to determine the prognostic value of DNA ploidy patterns for colorectal adenocarcinomas after resection. METHODOLOGY: We have prospectively collected tumor specimens from 420 patients with colorectal cancer since 1996. The DNA ploidy patterns were determined with the use of DNA flow cytometry. The correlation of DNA ploidy pattern and various characteristics of tumors and the prognostic significance of DNA ploidy patterns were evaluated by univariate as well as Cox's proportional hazard model. The disease-free survival curves were calculated with Kaplan-Meier's analysis, and the survival difference was determined by log-rank test. RESULTS: DNA ploidy patterns were diploid in 115 (27.4%) and aneuploid in 305 patients (72.6%). The pattern of DNA ploidy did not correlate with age, gender, location, differentiation, and stage of the tumors. In 146 patients who were followed up for at least 2 years, the disease-free survival curves were similar between the diploid and aneuploid group. Multivariate analysis disclosed that tumor staging was associated with the survival of patients but the DNA ploidy pattern had no prognostic significance. CONCLUSIONS: The DNA ploidy pattern was not a significant prognostic factor in short-term follow-up.

Adenocarcinoma↗

PubMed2004

[Prognostic factors of stage II rectal cancer].

BACKGROUND/AIMS: We aimed to verify the prognostic factors of stage II rectal cancer and the effect of radiation therapy on the survival and local recurrence rate. METHODS: This study was undertaken in 202 patients who underwent curative resection of rectal cancer and confirmed to be stage II between July 1989 and December 1996. Univariate and multivariate (Cox's model) analyses of survival were employed to identify prognostic factors. Statistical significance was assigned by p value of <0.05. RESULTS: Overall recurrence occurred in 32 patients. Four patterns of recurrence were observed: hematogenous recurrence in 17 patients, local recurrence in 11, peritoneal seeding in two and simultaneous hematogenous and local recurrence in two cases. Overall 5-year survival rate was 85.6% and 5 year disease free survival rate was 82.8%. There was no significant difference in local recurrence rate and survival according to radiation therapy or location of cancer. In multivariate analysis, the number of harvested lymph node was only a prognostic factor. CONCLUSIONS: The number of harvested lymph nodes has prognostic value in stage II rectal cancer. Postoperative radiation therapy should be considered for stage II rectal cancer with poor prognostic factors although radiation did not decrease local recurrence rate in present study.

Adolescent↗

PubMed2004

[Study of prognostic factors in patients with stage I non-small cell lung cancer].

OBJECTIVE: To analyze the prognostic factors in patients with stage I non-small cell lung cancer (NSCLC). METHODS: Fifty-eight patients with stage I NSCLC treated from 1991 to 1995 were retrospectively reviewed. The clinical features, histopathology and prognostic factors were analyzed by SPSS10.0 statistic software. The expression of c-myc, MDM2, c-erbB-2, EGFR, p53, p14(ARF), p16(INK4), p21(WAF1) and nm23 was detected by immunohistochemical assay. The overall survival rate, local-regional control rate and distant metastasis rate were observed. RESULTS: The overall survival rate, local-regional recurrent rate and distant metastasis rate were 71.1%, 11.1% and 33.5%, respectively. In univariate analysis, tumor cell differentiation was an independent prognostic factor (P = 0.028); overexpression of c-myc or c-erbB-2 had significantly poor overall survival and high distant metastasis rate (P < 0.05). The total oncogene immunoreactive score (IRS) and comprehensive IRS were associated with poor overall survival. In multivariate analysis, tumor cell differentiation and comprehensive IRS were independent prognostic factors for overall survival. Among the high-risk group of patients, those who had received chemotherapy seemed to have a higher overall survival rate and a lower distant metastasis rate in this study, but the difference was not statistically significant. CONCLUSION: For stage I NSCLC patients, tumor cell differentiation and comprehensive IRS are independent prognostic factors for overall survival. Adjuvant chemotherapy might somehow improve the survival for the patients with high-risk factors.

Adult↗

PubMed2004

Prognostic implications of Wilms' tumor gene (WT1) expression in patients with de novo acute myeloid leukemia.

BACKGROUND AND OBJECTIVES: The Wilms' tumor (WT1) gene is overexpressed in patients with most forms of acute leukemia. Several studies have reported the usefulness of quantitative assessment of WT1 expression as a molecular marker of minimal residual disease. However, the biological significance and the prognostic impact of WT1 overexpression in acute myeloid leukemia (AML) is still uncertain. DESIGN AND METHODS: We analyzed the prognostic relevance of WT1 expression in a cohort of 77 adult patients with AML, using a real-time quantitative reverse-transcription polymerase chain reaction approach. RESULTS: WT1 expression was significantly higher in AML patients than in normal controls (p = 0.0001). The normalized levels of WT1 with respect to the control gene for beta-glucuronidase (GUS) in AML samples showed a median WT1/GUS ratio of 0.93 (range 0-25). We classified the patients into two groups according to this ratio. Forty patients (52%) showed a WT1/GUS ratio 1. A ratio > 1, although significantly associated with FLT3 mutations, was the strongest independent prognostic factor for disease-free survival (p = 0.004), relapse risk (p = 0.005) and cumulative incidence risk (p = 0.01). This adverse prognostic value was more evident in patients aged 60 years and younger. INTERPRETATION AND CONCLUSIONS: The WT1/GUS ratio is an independent prognostic factor for predicting relapse in patients with AML and it could be included as part of the initial evaluation to establish more defined risk groups.

Acute Disease↗

PubMed2004

[MICM classification and prognostic analysis of 80 adolescents with acute lymphoblastic leukemia].

OBJECTIVES: To explore MICM classification and adverse prognostic factors in adolescents with acute lymphoblastic leukemia (ALL). METHODS: The MICM classification, clinical characteristics of 80 adolescents with ALL admitted to our hospital from January 1998 to December 2002 were retrospectively analyzed. Survival data were estimated by the Kaplan-Meier method and the prognostic factors were analyzed with the COX regression model. RESULTS: In the 80 patients, B-ALL and T-ALL accounted for 69.12% and 26.47%, respectively. The percentage of Ph(+)ALL was 18.37% (9/49), and that of hyperdiploidy was 4.08%. Patients at diagnosis with high leukocyte counts (> 50 x 10(9)/L) accounted for 27.94%. Among the 78 cases treated with VDP(L) or CODP(L) regimens, 73 (91.03%) obtained CR in 4 weeks. After a median follow-up of 24 months, the estimated 3-year disease-free survival (DFS) rates of patients receiving chemotherapy or allo-HSCT were (32.55 +/- 16.50)% and (69.58 +/- 8.72)%, respectively (P < 0.05). In COX analysis, high initial leukocyte counts (> 50 x 10(9)/L) and Philadelphia chromosome positivity were adverse prognostic factors for long-term survival. CONCLUSIONS: MICM classification has important clinical and prognostic significance in the risk-directed therapy of adolescents with ALL. The adverse prognostic features for these patients were high leukocyte counts, less incidence of chromosome hyperdiploidy and Ph chromosome positivity.

Adolescent↗

PubMedDate not supplied

Profiles and prognostic values of serum LDH isoenzymes in patients with haematopoietic malignancies.

Serum lacticodehydrogenase (LDH) is commonly increased in patients with haematopoietic malignancies and has been shown to be a prognostic factor in patients with non-Hodgkin's lymphoma (NHL) and myeloma. We have examined the LDH isoenzyme content in serum of 326 patients, including 252 patients with NHL (202 at diagnosis and 50 at relapse), 28 patients with Hodgkin's disease, 17 patients with CLL, 16 patients with myeloproliferative syndromes and 13 patients with multiple myeloma. Among these, 160 pts (49%) had increased serum LDH. The analysis of LDH isoenzyme profiles in all patients showed increased percentages of isoenzyme 2 in patients with NHL, CLL and myeloproliferative syndromes, but not in samples from patients with myeloma or Hodgkin's disease. Isoenzyme alterations were then analyzed for their prognostic value in patients with NHL. In univariate analyses, increased isoenzyme 2 percentages, increased isoenzyme 3 values, total serum LDH, performance status, stage and tumour aggressiveness were prognostic variables for survival. In a multivariate analysis increased LDH isoenzyme 3 values, high isoenzyme 2 percentages and the performance status, but not total serum LDH, were independent prognostic factor for survival. High isoenzyme 3 values were predictive of early death in NHL patients. In patients with relapsing NHL, the overall survival was 12 months in patients with normal isoenzyme 3 but only 2 months in patients with increased isoenzyme 3 values. We conclude that there are characteristic alterations in serum LDH profiles in patients with haematopoietic malignancies and that some of these may be more interesting in terms of prognostic value than total serum LDH.

Adolescent↗

PubMed2004

[Comprehensive prognostic value of spontaneous and evoked electromyography in laryngeal paralysis].

OBJECTIVE: To determine the comprehensive prognostic value of spontaneous and evoked electromyography (EMG) in laryngeal paralysis. METHODS: The characteristics of laryngeal EMG of 91 cases with unilateral vocal cord paralysis (VCP) after thyroid surgery were assessed. All cases were divided into four groups according to the interval of laryngeal EMG after onset, which were group one (2 months shorter, n = 13), group two (2 to 4 months, n = 23), group three (4 to 6 months, n = 36), group four (6 months longer, n = 19). The waveform morphology and the amplitude of laryngeal EMG and the highest evoked compound muscular active potential (CMAP) of thyroarytenoid muscles were examined and analyzed during voluntary tasks. The potential amplitude was showed by the percentage of that of the healthy lateral. The criterion of evaluation on evoked potential was attained by calculating statistical confidence interval. RESULTS: The highest evoked CMAP in group one was significantly lower than that of the others (P < 0.05), but no significant difference was observed between group two and group three (P > 0.05), so group two and group three were analyzed together. There were 2 recovered cases and 11 unrecovered cases in group one. On the basis of this criterion that a positive prognosis for laryngeal recovery was indicated when the evoked CMAP presented and there was no misdirect generated potential, correct prognostic rate was 92% (12/13). There were 11 recovered cases and 48 unrecovered cases in group two and three. The highest evoked CMAP was much higher in the recovered than in the unrecovered, significant difference was observed between them (P < 0.001). On the basis of the criterion that a positive prognosis for laryngeal recovery was indicated when the highest evoked CMAP was higher than 26. 4%, correct prognostic rate was 90% (53/59). On the basis of the criterion that a positive prognosis for laryngeal recovery was indicated when there was no misdirect generated potential and the highest evoked CMAP was higher than 26.4%, correct prognostic rate was 93% (55/59). When the interval from onset to laryngeal EMG recovering was longer than 6 months, none of these patients had return of vocal cord mobility whatever were the outcomes of laryngeal EMG. CONCLUSIONS: Correct prognostic rate can be improved if the prognosis of VCP in different courses is judged respectively by analyzing comprehensively spontaneous and evoked EMG.

Adult↗

PubMed2004

Clinical characteristics and prognostic determinants of infective endocarditis in adult intravenous drug users.

BACKGROUND AND PURPOSE: Infective endocarditis (IE), one of the most serious complications of intravenous (IV) drug use, has been increasing in incidence in the past decade in Taiwan. The difference in prognostic determinants for IE between patients with and without IV drug use is poorly understood. This study investigated the clinical profile and prognostic determinants of IE in IV drug users. METHODS: The medical records for 157 episodes (30 episodes in IV drug users and 127 episodes in non-drug users) of IE in 143 consecutively hospitalized patients were retrospectively evaluated. Independent prognostic determinants were identified by multiple Cox proportional hazards regression analysis. RESULTS: IV drug users were younger with a predominance of males. They also had a higher frequency of right-sided IE, underlying disease, and had a larger area of vegetation than non-drug users. Staphylococci were the most common causative microorganisms in IV drug users while streptococci were more common in non-drug users. Septic pulmonary embolism and septic complications were more frequent in IV drug users. In-hospital mortality was similar between the 2 groups. Non-cardiac shock was the only significant prognostic determinant in IV drug users (odds ratio [OR] 15.5; 95% confidence interval [CI] 3.0 to 81.5); however, in non-drug users, non-cardiac shock (OR, 4.4; 95% CI, 2.0 to 9.8), older age (> or = 50 years), and neurological complications were independent predictors of in-hospital mortality. CONCLUSIONS: The clinical characteristics and prognostic determinants of IE in IV drug users were significantly different from those of non-drug users. IV drug users were less likely to have a benign clinical course and had a higher frequency of septic complications. These findings indicate the importance of risk stratification and modified treatment strategy in IV drug users who develop IE.

Adult↗

PubMedDate not supplied

Analysis of correlation between mitotic index, MIB1 score and S-phase fraction as proliferation markers in invasive breast carcinoma. Methodological aspects and prognostic value in a series of 257 cases.

BACKGROUND: The study was designed in order to evaluate the degree of correlation of mitotic index (MI), Ki67 (MIB1) score and S-phase fraction (SPF) as markers of cell proliferation and prognosis in breast cancer. MATERIALS AND METHODS: The series analysed corresponded to 257 consecutive invasive breast carcinoma, treated at the Institut Curie, France, in 1995. Nottingham histological grade and MIB1 semiquantitative and quantitative score were assessed on histological sections, whereas SPF was calculated using flow cytometry analysis of fine-needle aspiration products. Proliferation indices were compared to pathological data and to overall survival (OS) and disease-free survival (DFS) (minimum follow-up: 72 months). RESULTS: The median values for the proliferation markers were 9/10 HPF for MI, 32.4% for MIB1 and 3.7% for SPF. A high rate of correlation (r=0.96; p<0.001) was observed between semi-quantitative and quantitative MIBI evaluation. A positive correlation was found between the three markers (r ranging from 0.54 to 0.61;p<0.001). Univariate analysis of markers associated to disease outcome showed that MIB1, axillary node status (N) and progesterone receptor (PR) status were significantly associated with OS and that MIB1 and SPF were associated with DFS, together with node and hormone receptor status. In multivariate analysis, when proliferation markers were adjusted on the N and PR status, only MIB1 retained a prognostic value for OS (RR= 1.83) [1.00;3.35] and SPF for DFS (RR= 1.58) [1.02-2.44] (p=0.04). CONCLUSION: A good level of correlation was observed between the values of the three markers of tumour cell proliferation analysed. In this series of invasive breast cancers, MIB1 immunostaining was found to be a prognostic marker of both OS and DFS. The median (32.4%) was a valuable cut-off value for prognostic assessment. Semi-quantitative and quantitative evaluations provided very similar values. MIB1 can thus be considered as a reliable prognostic maker, usable in small size tissue specimens which are inappropriate for MI or SPF analysis. The impact of MIB1 compared to that of the other proliferative markers will be further assessed in a subgroup of T1N0M0 for which the prognostic assessment is of major interest.

Adult↗

PubMed2004

[Association between the expression of estrogen receptor subunit in endometrial carcinoma and the prognostic factors of endometrial carcinoma].

OBJECTIVE: To study the relationship between the expression of ERalpha and ERbeta mRNA in the fresh tissue from patients with endometrial carcinoma and to evaluate the association between the ratio of ERalpha/ERbeta and the prognostic factors of endometrial carcinoma. METHODS: Multiplex RT-PCR was used to study the expression of ERalpha and ERbeta mRNA in the fresh endometrial tissue from 41 cases of endometrial carcinoma. The association between the expression of ERalpha/ERbeta mRNA and the prognostic factors of endometrial carcinoma was evaluated. RESULTS: ERalpha mRNA and ERbeta mRNA were detected in 95% and 90.2% of the 41 cases of endometrial carcinoma, respectively. ERalpha/ERbeta > 1 was detected in 21 cases and ERalpha/ERbeta < 1 was detected in 14 cases. Analysis revealed an association between the ratio of ERalpha/ERbeta mRNA and the prognostic factors of endometrial carcinoma. CONCLUSION: In this study, ERalpha mRNA overexpression (ERalpha/ERbeta > 1) was found associated with good prognostic factors of endometrial carcinoma, whereas ERbeta mRNA overexpression (ERalpha/ERbeta < 1) was found associated with poor prognostic factors of endometrial carcinoma.

Adenocarcinoma↗

PubMed2004

Laminin, Her2/neu and Ki-67 as prognostic factors in non-small cell lung cancer.

PURPOSE: The aim of this study was to determine the values of Ki-67 antigen, oncoprotein Her2/neu and laminin, as prognostic and predictive factors in NSCLC, and on the basis of these markers to create a prognostic model which would make it possible to identify patients with a high risk of disease recurrence. MATERIAL AND METHODS: The material for the study came from 64 patients with NSCLC, who underwent surgery in Dolnoślaskie Centrum Gruźlicy i Chorób Płuc i 1996-2000, and subsequently were given radiation therapy in Dolnoślaskie Centrum Onkologii. RESULTS: Among the markers researched, a high level of (intracellular) laminin in carcinoma cells was found to be an unfavourable prognostic factor. Also, another group of patients with an overexpression of oncoprotein Her2/neu were found to have a poorer prognosis, although the influence of proliferative index Ki-67 on patient survival could not be explained. The prognostic model LAMHER, which was defined on the basis of the intracellular laminin level and expression HER2/neu, enables the identification of a group of patients with a high risk of disease recurrence. In a multidimensional analysis of the "classification tree", it was found that patients with the highest risk of disease recurrence were those with LAMHER = 1 (overexpression Her2/neu and/or a high level of intracellular laminin), and patients with LAMHER = 0 but a Fractionation Dilution Factor higher than 1.57. CONCLUSIONS: The conclusion of this study is that multiple molecular marker testing is necessary to detect an independent prognostic impact on survival and is therefore superior to single marker testing. Based on LAMHER testing, two groups of patients could be defined: a low-risk group (LAMHER = 0) and a high-risk group (LAMHER = 1) for failure of standardized treatment.

Biomarkers, Tumor↗

PubMed2005

Prognostic stratification using dobutamine stress 99mTc-tetrofosmin myocardial perfusion SPECT in elderly patients unable to perform exercise testing.

UNLABELLED: Information on the prognostic value of noninvasive stress imaging techniques in the elderly is relatively scarce. This study assessed the prognostic value of dobutamine stress (99m)Tc-tetrofosmin SPECT for the prediction of mortality and cardiac events in elderly patients. METHODS: Clinical information and SPECT results were analyzed for 272 consecutive patients > or = 65 y old (mean age, 71 +/- 5 y; range, 65-87 y) with limited exercise capacity. Follow-up was complete in 270 patients (99.3%); 23 underwent revascularization within 60 d of the scintigraphy and were excluded. Abnormal findings were defined as the presence of a fixed or reversible perfusion defect. A summed stress score was obtained to estimate the extent and severity of perfusion defects. The incremental prognostic value of SPECT over clinical data was evaluated according to 3 multivariate models, which included any SPECT abnormality, the presence of a fixed or reversible defect, and the summed stress score. RESULTS: During the follow-up (3.3 +/- 1.4 y), 59 patients died (29 cardiac deaths), 16 had a nonfatal infarction, and 49 underwent late revascularization. Abnormal scan findings were present for 140 patients (57%). The annual event rates for total mortality, cardiac death, and cardiac death or nonfatal infarction were, respectively, 3.2%, 0.2%, and 0.7% when scan findings were normal and, respectively, 9.5%, 4.3%, and 8% when scan findings were abnormal (all P < 0.0001). Multivariate analysis showed that abnormal scan findings, the presence of a fixed or reversible defect, and the summed stress score provided incremental prognostic information over clinical data. The presence of abnormal scan findings was independently associated with an increased risk for total mortality, cardiac death, and cardiac death or nonfatal infarction (respectively, hazard ratio 3.4 [95% CI, 1.8-6.5], 12.1 [95% CI, 2.9-51.5], and 9.0 [95% CI, 2.8-29.6]). CONCLUSION: Dobutamine stress (99m)Tc-tetrofosmin SPECT provides incremental prognostic information for the prediction of total mortality and cardiac events in elderly patients.

Aged↗

PubMed2004

[Survival and prognostic factors of non small cell lung cancer: analytic review of 211 cases].

Prognostic factors have a pivotal role in clinical oncology. They are helpful in the selection of treatment, provide insights into the disease process and the therapeutic response. The number of possibly useful prognostic factors in the lung cancer is large. This study attempts to observe the survival of non small cell lung cancer (NSCLC) and to find prognostic factors and other variables potentially associated with outcome of lung cancer. It's a retrospective study based on 211 patients with NSCLC. Median survival was 6 months with 95% confidence interval: [4.2 - 7.8]. Overall 3 and 5 year survival were respectively 8.3% and 5.2%. Various Prognostic factors have been identified through univariate (Kaplan-Meier) then multivariate (Cox) analyses. In addition to the clinical factors such as age, disease extent and performance status, other variables were found of significant prognostic value, like pretherapeutic leukocyte level. Survival was significantly improved with surgery, radiation and also with chemotherapy, mainly in advanced stage (IIIB and IV).

Adenocarcinoma↗

PubMed2005

Prognostic value of automated quantification of 99mTc-sestamibi myocardial perfusion imaging.

UNLABELLED: Although human interpretation of (99m)Tc-sestamibi SPECT myocardial perfusion imaging has been repeatedly validated in the diagnostic and prognostic assessment of coronary artery disease, it remains unclear if automated computer-derived quantitative indices of perfusion have similar or independent prognostic information. METHODS: We studied 718 patients referred for (99m)Tc-sestamibi SPECT myocardial perfusion imaging who were followed for 5.6 +/- 1.1 y (mean +/- SD). The SPECT studies were initially interpreted visually without benefit of computer-based analysis and were then subjected to a blinded reprocessing to extract quantitative indices of perfusion. Follow-up was through the Manitoba Population Health Research Data Repository. Acute myocardial infarction or cardiac death occurred in 79 individuals (11.0% of the cohort). RESULTS: Visual and quantitative categorization of scan perfusion abnormalities showed similar prognostic value for predicting acute myocardial infarction or cardiac death. Discordance between the visual and quantitative categorizations defined a group at intermediate risk. There was a gradient of risk with increasing severity of the summed stress score (SSS) or summed difference score (SDS). The automated SSS and SDS provided incremental prognostic information over that obtained from visual interpretation. CONCLUSION: Automated quantification of (99m)Tc-sestamibi SPECT myocardial perfusion scans provides objective prognostic information and may complement the conventional visual image interpretation.

Causality↗

PubMed2004

Cardiac death and heart failure following primary angioplasty in extensive myocardial infarction: incremental prognostic value of clinical, functional and angiographic data.

BACKGROUND: The incidence of late severe heart failure after primary angioplasty is not clear and few data are available about the clinical prognostic predictors of this event. The aims of our study were a) to evaluate the incidence of cardiac death and heart failure after an extensive acute myocardial infarction treated with primary angioplasty, and b) to identify, among clinical, ECG, functional, and angiographic variables, the outcome predictors and their incremental prognostic value. METHODS: Two hundred and thirty-three patients with ST-segment elevation in > or = 4 leads, without cardiogenic shock, underwent primary angioplasty within 12 hours of symptom onset and were prospectively followed up for a median of 21 months for the combined endpoint of cardiac death and heart failure. The effects of clinical, ECG, functional, and angiographic data on the combined endpoint were evaluated using Cox's analysis. Separate models were developed including all variables of a given model plus significant variables of previous models to reproduce the usual clinical information flow. RESULTS: Twelve (5%) deaths and 23 (10%) heart failures occurred. Diabetes (hazard ratio [HR] 6.46, 95% confidence interval [CI] 1.99-20.98) and peak creatine kinase-MB (HR 1.002, 95% CI 1.001-1.004 per unit increment), wall motion score index (HR 1.46, 95% CI 0.35-6.15 per 0.1 unit increment), and TIMI flow grade < 3 after angioplasty (HR 5.35, 95% CI 2.04-14.02) were the only significant and independent prognostic indicators. ECG information did not improve the model, whilst functional and angiographic data provided incremental prognostic value over clinical information. CONCLUSIONS: At mid-term follow-up, extensive acute myocardial infarction patients undergoing primary angioplasty have a moderate heart failure event rate. The integrated evaluation of data routinely available from diagnostic work-up allows accurate prediction of the outcome; functional and angiographic data provide incremental prognostic information over clinical and ECG variables.

Aged↗

PubMed2005

A new look at the prognostic value of the estrogen, progesterone and epidermal growth factor receptors in breast cancer tissue.

The aim of the study was to evaluate the influence of the receptor status of primary breast cancer and of a number of selected clinical and morphological patient characteristics. The receptors were determined by biochemical radiocompetitive methods. Disease free survival (DFS) and overall survival (OS) were determined by Cox proportional hazard model. The influence of ER, PR, and EGFR on patient survival was analyzed in two ways: 1) as a separate parameter of each receptor and 2) as a common parameter consisting of 8 variables of concomitant presence or absence of the receptors. The first set of analyses had shown that EGFR as an independent parameter had no prognostic value either for DFS or OS because of a lack of statistical significance. Higher ER concentrations were positive and lower concentrations were negative prognostic factors, but only for DFS. PR was always a positive prognostic factor for DFS and OS and its prognostic value increased with concentration increase. In the second analysis it was found that patients with receptor status ER+PR+EGFR+; ER-PR+EGFR-; ER+PR+EGFR-; and ER-PR-EGFR- were having better parameters of DFS and OS (relative risks for DFS or OS were between 0.22-1.16). The patients with receptor status: ER-PR+EGFR+; ER+PR-EGFR-, ER-PR-EGFR+ and ER+PR-EGFR+ exhibited a more aggressive disease course (relative risks for DFS and OS were between 1.46-3.95). Moreover, it was found that tumor size, nodal status and patient age were independent prognostic factors for DFS and OS of patients.

Adult↗

PubMed2005

Chronic lymphocytic leukemia: novel prognostic factors and their relevance for risk-adapted therapeutic strategies.

BACKGROUND AND OBJECTIVES: Many years ago it was established that prompt treatment of early stage chronic lymphocytic leukemia (CLL), the stage at which almost two-thirds of CLL patients present, has no benefit over a management of watching and waiting, then treating progression. However, this fact was based on series treated ineffectually with chlorambucil, which were not stratified according to prognostic markers. DESIGN AND METHODS: The prognosis and clinical course of CLL are heterogeneous. While some patients may have a normal life expectancy without requiring treatment, others die of drug-resistant disease as early as within two years of presentation. However, unlike the situation in non-Hodgkin's lymphoma, there is no standard Prognostic Index that can be used to group patients with CLL according to likely outcome or to guide treatment. RESULTS: A number of clinical and biological factors of prognostic relevance, which may add to the classical assessment provided by the staging systems, have been identified. These include clinical characteristics, such as age, gender and performance status, and laboratory parameters reflecting the tumor burden or disease activity, such as lymphocyte count, lactate dehydrogenase (LDH) increase, bone marrow infiltration pattern or lymphocyte doubling time. Recently more informative prognostic parameters have been identified: serum markers such as soluble CD23, b2-microglobulin or thymidine kinase and genetic markers of tumor cells, such as genomic aberrations, gene abnormalities (p53, ATM), the mutation status of the variable segments of the immunoglobulin heavy chain genes (IGVH) or surrogate markers for these factors, such as CD38 and ZAP-70. INTERPRETATION AND CONCLUSIONS: From the clinician's perspective the importance of this new knowledge is how it affects treatment. It is now possible to produce molecular remissions even in advanced disease using combinations of purine analogs and monoclonal antibodies. Moreover, potentially curative therapeutic modalities such as autologous and allogeneic stem cell transplantation are becoming safer. Clinical trials of effective treatment stratified by more reliable prognostic markers are surely now warranted.

Biomarkers↗

PubMedDate not supplied

Tnm independent prognostic factors in lung cancer.

Large studies have demonstrated that TNM staging system is the most consistent prognostic factor in patients with non small cell lung carcinoma. However, because patients within the same stage may have very different survival, better prognostic information is needed. The recent progress in molecular biology has allowed the analysis of proteins and genes involved in cancer development. To date, more than 150 different prognostic factors affecting survival in patients with lung cancer have been discovered and extensively studied. Despite the encouraging prognostic results in angiogenesis markers, there is not yet a molecular marker validated in large prospective trials that has major independent predictive prognostic value.

Humans↗